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For impaired individuals a stable drug free state is not a likely
outcome of an initial course of treatment.1
For the impaired Psyche addictive disorders are
similar to other chronic disorders such as arthritis or
diabetes, and treatment success is best measured in terms of reduction of
symptoms not cure. In these terms, treatment success rates for impaired
chemically dependent individuals are comparable to those of other chronic
disorders. But if good outcome is defined by cure, the success rates
are quite low.
Clearly, self-determination is not a realistic treatment goal for the
Psyche that is or has become impaired.
Expecting such an outcome is unrealistic and sets the stage for
demoralization of both staff and patients. Treatment for the
impaired, chemically dependent individual is best measured in terms of
reduction of symptoms or harm. When viewed this way, good treatment
produces outcome that compares favorably with those of other chronic
disorders.2
There has been little emphasis on developing these
skills, because many substance abusers are
too impaired to benefit from such an approach. For
seriously impaired individuals the disease
model of addiction is most appropriate, because they require treatment
in the conventional sense. Outcome is best when
they accept the passive, patient role
and comply with an externally imposed treatment protocol.
Treatment efforts focus on
getting the patient to admit they are victims of disease over which they
are powerless. For impaired individuals this is a good strategy,
because they can easily convince themselves that
they are not really chemically dependent and
thus don't have to follow rigid rules.
For impaired individuals this belief produces
disastrous results.
Footnotes
1. .
Recent developments in
the pharmocology of substance abuse. C.
O'Brien.
opment Book Antiqua; color: black">
Journal of Consulting and Clinical Psychology,
1996, 64, 677-686.
2. Ibid.
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In the beginner's mind there are many possibilities; in the expert's
mind there are few.
- S. Roshi
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